The science behind ringing in the ears - a new perspective on tinnitus

The science behind tinnitus

- A new perspective on tinnitus -

Tinnitus is much more than just a sound in the ears.
It's a complex condition affecting millions worldwide, and the solution lies not in the ear, but in the brain.‍

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_{Did you know that 14.4% of adults worldwide experience tinnitus? And that for 2% of them, the symptoms significantly impact daily life?}

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- What is tinnitus? -

Sound without a source

Tinnitus is the perception of sound (whistling, buzzing, or humming) without an external sound source being present. Most people experience subjective tinnitus, which only they can hear. A rarer objective form can be observed by a doctor, due to problems with blood vessels or muscle tension.

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- The role of the brain -

Not an ear problem, but a brain problem

Tinnitus is the result of an interaction between hearing and the brain. When there is damage to the inner ear, the brain increases its internal sensitivity to compensate for signal loss, a process called "central gain increase".

This amplifies neural noise, which is then mistakenly interpreted as real sound.
Additionally, the natural rhythms between the thalamus and the auditory cortex become disrupted (thalamocortical dysrhythmia), and a noise suppression system in the prefrontal cortex fails, causing the phantom sound to persist chronically.

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- Treatment -

How is tinnitus treated?

While a complete cure doesn't exist yet, various methods can alleviate the distress:

- Cognitive behavioral therapy: Changing the negative emotional reaction to the sound.

- Hearing rehabilitation: Hearing aids or cochlear implants for accompanying hearing loss.

- Addressing comorbidities: Treating sleep, anxiety, and depression for a better quality of life.

- Neuromodulation: Direct intervention in brain activity.

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- Neuromodulation -

Non-invasive techniques

Neuromodulation is the most promising research area for tinnitus.
Four techniques are used in specialized centers:

TMS (Transcranial magnetic stimulation)

Magnetic pulses dampen overactivity in specific brain regions, thereby inhibiting the networks responsible for maintaining the phantom sound. Conversely, activating certain brain regions can be beneficial for stimulating the 'noise suppression system'.

TES (Transcranial electrical stimulation)

Weak electrical current affects the excitability of brain regions. This gentle technique can influence an entire brain network.

Neurofeedback (retraining the brain)

Patients learn to control their own brainwaves through real-time feedback.

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The future of tinnitus treatment is moving towards personalized care:
Based on an individual's specific brain profile, the most effective stimulation methods are chosen.

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